John P Fischer1, Ari M Wes2, Jonas A Nelson2, Marten Basta2, Jeffrey I Rohrbach3, Liza C Wu2, Joseph M Serletti2, Stephen J Kovach2. 1. Division of Plastic Surgery, Perelman School of Medicine at the Hospital of the University of Pennsylvania, Philadelphia, PA. Electronic address: John.Fischer2@uphs.upenn.edu. 2. Division of Plastic Surgery, Perelman School of Medicine at the Hospital of the University of Pennsylvania, Philadelphia, PA. 3. Division of Finance, Perelman School of Medicine at the Hospital of the University of Pennsylvania, Philadelphia, PA.
Abstract
BACKGROUND: Choosing a breast reconstructive modality after mastectomy is an important step in the reconstructive process. The authors hypothesized that autologous tissue is associated with a greater success rate and cost efficacy over time, relative to implant reconstruction. STUDY DESIGN: A retrospective review was performed of patients undergoing free tissue (FF) transfer and expander implant (E/I) reconstruction between 2005 and 2011. Variables evaluated included comorbidities, surgical timing, complications, overall outcomes, unplanned reoperations, and costs. A propensity-matching technique was used to account for the nonrandomized selection of modality. RESULTS: A total of 310 propensity-matched patients underwent 499 reconstructions. No statistically significant differences in preoperative variables were noted between propensity-matched cohorts. Operative characteristics were similar between FF and E/I reconstructions. The E/I reconstruction was associated with a significantly higher rate of reconstructive failure (5.6% vs 1.2%, p < 0.001). Expander implant reconstructions were associated with higher rates of seroma (p = 0.009) and lower rates of medical complications (p = 0.02), but overall significantly higher rates of unplanned operations (15.5% vs 5.8%, p = 0.002). The total cost of reconstruction did not differ significantly between groups ($23,120.49 ± $6,969.56 vs $22,739.91 ± $9,727.79, p = 0.060), but E/I reconstruction was associated with higher total cost for secondary procedures ($10,157.89 ± $8,741.77 vs $3,200.71 ± $4,780.64, p < 0.0001) and a higher cost of unplanned revisions over time (p < 0.05). CONCLUSIONS: Our matched outcomes analysis does demonstrate a higher overall, 2-year success rate using FF reconstruction and a significantly lower rate of unplanned surgical revisions and cost. Although autologous reconstruction is not ideal for every patient, these findings can be used to enhance preoperative discussions when choosing a reconstructive modality.
BACKGROUND: Choosing a breast reconstructive modality after mastectomy is an important step in the reconstructive process. The authors hypothesized that autologous tissue is associated with a greater success rate and cost efficacy over time, relative to implant reconstruction. STUDY DESIGN: A retrospective review was performed of patients undergoing free tissue (FF) transfer and expander implant (E/I) reconstruction between 2005 and 2011. Variables evaluated included comorbidities, surgical timing, complications, overall outcomes, unplanned reoperations, and costs. A propensity-matching technique was used to account for the nonrandomized selection of modality. RESULTS: A total of 310 propensity-matched patients underwent 499 reconstructions. No statistically significant differences in preoperative variables were noted between propensity-matched cohorts. Operative characteristics were similar between FF and E/I reconstructions. The E/I reconstruction was associated with a significantly higher rate of reconstructive failure (5.6% vs 1.2%, p < 0.001). Expander implant reconstructions were associated with higher rates of seroma (p = 0.009) and lower rates of medical complications (p = 0.02), but overall significantly higher rates of unplanned operations (15.5% vs 5.8%, p = 0.002). The total cost of reconstruction did not differ significantly between groups ($23,120.49 ± $6,969.56 vs $22,739.91 ± $9,727.79, p = 0.060), but E/I reconstruction was associated with higher total cost for secondary procedures ($10,157.89 ± $8,741.77 vs $3,200.71 ± $4,780.64, p < 0.0001) and a higher cost of unplanned revisions over time (p < 0.05). CONCLUSIONS: Our matched outcomes analysis does demonstrate a higher overall, 2-year success rate using FF reconstruction and a significantly lower rate of unplanned surgical revisions and cost. Although autologous reconstruction is not ideal for every patient, these findings can be used to enhance preoperative discussions when choosing a reconstructive modality.
Authors: Jonas A Nelson; Sophocles H Voineskos; Ji Qi; Hyungjin M Kim; Jennifer B Hamill; Edwin G Wilkins; Andrea L Pusic Journal: Plast Reconstr Surg Date: 2019-12 Impact factor: 4.730
Authors: Edwin G Wilkins; Jennifer B Hamill; Hyungjin M Kim; John Y Kim; Richard J Greco; Ji Qi; Andrea L Pusic Journal: Ann Surg Date: 2018-01 Impact factor: 12.969
Authors: David J Restrepo; Maria T Huayllani; Daniel Boczar; Andrea Sisti; Minh-Doan T Nguyen; Jordan J Cochuyt; Aaron C Spaulding; Brian D Rinker; Galen Perdikis; Antonio J Forte Journal: Medicina (Kaunas) Date: 2020-06-08 Impact factor: 2.430
Authors: Justin M Broyles; Ethan M Balk; Gaelen P Adam; Wangnan Cao; Monika Reddy Bhuma; Shivani Mehta; Laura S Dominici; Andrea L Pusic; Ian J Saldanha Journal: Plast Reconstr Surg Glob Open Date: 2022-03-11
Authors: Ali A Qureshi; Kristen Broderick; Susan Funk; Nancy Reaven; Marissa M Tenenbaum; Terence M Myckatyn Journal: Plast Reconstr Surg Glob Open Date: 2016-08-09